Exam Flashcards
3 periods of stress
-As a physiologic response
-As a Stimulus
-As a Person–Environment Transaction
allostasis
-maintaining stability through change
-Describes how the cardiovascular system adjusts to resting and active states of the body
-different environmental circumstances or conditions require different set points
-Maintaining an allostatic balance in wide-ranging circumstances calls for continuous systemic adjustments throughout the whole body
allostatic load
- the cumulative negative effects on the body of continually having to adapt to changing environmental conditions and psychosocial challenges
- it is the sum total of the “wear and tear” on the body that accumulates from the constant effort required to maintain normal body rhythms in the face of change and stress
stress as a physiological response
environmental changes are perceived as threats to personal integrity or safety and signal a compensatory response mediated by the sympathetic branch of the autonomic nervous system
adaptation syndrome
-stress (a nonspecific response of the body to any demand placed on it)
-stressors (events that initiate the response)
-can be physical (e.g., infection, intense heat or cold, surgery, debilitating illnesses)
-psychological (e.g., psychological trauma, interpersonal problems)
-social (e.g.,lack of social support).
-short term (acute) or long term (chronic).
automatic responses to stress
1) alarm reaction → all body systems respond to mediate the stressor, if successful the body returns to normal, if not successful and stressor continues the body moves into resistance
2) Resistance → efforts to adapt continue
3) Exhaustion → when stressor becomes chronic or extreme, individuals resources are depleted
Recent life changes questionnaire (RLCQ)
Family
Personal
Work
Financial
Stress as a Person Environment Transaction
-stress as resulting from a perceived imbalance between an individual’s resources and the demands placed on them
-stress depends on how a stressor is appraised in relation to the individual’s resources for coping with it
cognitive appraisal
-the process by which individuals examine the demands and constraints of a situation in relation to their own personal and network resources
-Primary - individuals evaluate the situation and determine whether they are in danger or under threat
-Secondary - the individual considers the options for dealing with the situation
Physiological Stress Response
-The physiologic response to stress begins in the central nervous system (CNS) but quickly involves all body systems.
-Sympathetic response
-hypothalamic–pituitary–adrenocortical (HPA) axis and the sympathetic–adrenal medullary system
-Corticotropin releasing hormone → adrenocorticotropic hormone → cortisol
-Immune system functioning affected negatively
-Over time, biologic responses to stress compromise a person’s health status
structural social support
quantitative characteristics of social support network (size, number of connections)
functional social support
quality of relationships, degree to which one believes help is available
dissupport
some relationships can be harmful, stressful, and even damaging to ones self esteem
coping
-“the efforts we take to manage situations we have appraised as being potentially harmful or stressful”
-it continually changes over the course of an encounter
-it consists of what an individual thinks and does in response to the perceived demands of a situation
-Positive coping → adaptation, well-being and maximum social functioning
-inability to cope → maladaptation, ill health, a diminished self-concept, and deterioration in social functioning.
problem focused coping
-Focuses on changing the relationship between the environment and the person
-Outer - eliminate or alter a situations or another persons behaviour
-Inner - altering one’s own beliefs, attitudes, skills, responses
emotion focused coping
individuals seek to manage their emotional distress (e.g., through exercise, prayer/meditation, expressing emotions, talking to friends)
traumatic stressor
“any event (or events) that may cause or threaten death, serious injury, or sexual violence to an individual, a close family member, or a close friend.”
acute stress disorder
-Occurs within one month of a highly traumatic event (resolving within 4 weeks).
-an individual has experienced, personally or through witnessing others’ experience(s), a severe threat in which life or injury is or appears to be at stake.
-This experience must then continue to affect the individual’s mental health status in such areas as arousal, intrusive memories, and changes in behaviour and functioning.
At least three dissociative symptoms present:
-a subjective sense of numbing, detachment, or absence of emotional responsiveness
-a reduction in awareness of surroundings
-derealization (a sense of unreality related to the environment)
-depersonalization (a sense of unreality or self-estrangement)
-dissociative amnesia
post traumatic stress disorder
-individual experiences or witnesses an authentic, severe threat of death or injury (including sexual injury) to self or others and this experience then affects the individual’s mental health in specific ways
Major features of PTSD are persistent:
-Re-experiencing of the trauma through recurrent intrusive recollections
-Avoidance of memories of the trauma
-Flashbacks
-Avoidance of stimuli associated with the trauma
-Numbing of general responsiveness
-Increased arousal – irritability, difficulty sleeping, difficulty concentrating, hypervigilance, or exaggerated startle response
-Factors that predict the development of PTSD include being female, type and severity of the trauma, past trauma (including childhood physical, sexual, and emotional abuse), and availability of support at the time of the stressful event
treatment for ptsd
cognitive–behavioural therapy (CBT)
psychotherapy
eye movement desensitization and reprocessing (EMDR)
medication
eye movement desensitization and reprocessing (EMDR)
A structured therapy that encourages the patient to briefly focus on the trauma memory while simultaneously experiencing bilateral stimulation (typically eye movements), which is associated with a reduction in the vividness and emotion
Intergenerational Transmission of Stress, Trauma, and Resilience
-The effects of stress and trauma experienced in one generation can be transmitted to the subsequent generations.
-Adverse experiences in childhood and adulthood may influence
-The transmission of such risk across generations can be mitigated by various protective factors—including internal assets and external resources.
collective trauma
-Occurs when a traumatic event is experienced by a significant proportion of a given social group. (natural disaster, genocide)
-It can have long-term consequences for the social group beyond its additive effect on individuals such that social norms, dynamics, functioning, and structure of the group may be modified.
-The effects at the family and community levels can modify social norms, dynamics, structures, and functioning that are more than the sum of the individual-level effects
-may be cumulative and be carried forward to subsequent generations
historical trauma
process by which a social group is affected by the consequences of multiple, collectively experienced adversities across time that outweigh group resiliency factors, become cumulative, and are carried forward to subsequent generations such that the trauma may be considered as part of a single trajectory
Responses to Collective and Historical Trauma
-collective approaches will often have the most benefits from a public health perspective when resources are limited
-community-level mental health and psychosocial support interventions have been shown to help communities affected by disasters
-community-based approaches enable interventions to reach a larger target population, as well as undertake preventive and promotional public mental health activities at the same time.
-A long-term goal of historical trauma intervention research and practice is to reduce inequities faced by indigenous people
trauma informed care
an approach to all clients that is based on knowledge of trauma and its effects with policies and practices incorporating principles of safety, choice, and control, as well as compassion, collaboration, and trustworthiness
nursing care of individuals affected by stress
-Explore recent changes (positive or negative)
-Eliminate or moderate the stressor
-Reduce the effects of stress response
-Development and maintenance of positive coping skills
stress interventions
Biologic
-Establish regular routine (eating, sleeping, self care)
-Exercise
-Yoga, meditation, deep breathing, progressive muscle relaxation
-Hypnosis, biofeedback, EMDR
Psychological
-Lifestyle changes
-CBT
-Psycheducation
-Relaxation therapy
-Assertiveness training
Social
-Promote social network
-Educate family
crisis
esponse occurs when an individual encounters an obstacle or problem that might affect his or her life goals and that cannot be solved by customary problem-solving methods. It is acute, is time limited, and may be developmental, situational, or interpersonal in nature.
situational crisis
-any event that overwhelms an individual’s coping resources and upsets his or her equilibrium
-illness, the death of a loved one, separation or divorce, job loss, school problems, physical or sexual assault, or an unplanned pregnancy
developmental crisis
-demands from the social environment exert pressure on an individual to move on to the next developmental stage and that a failure to meet these new expectations precipitates a developmental crisis
-Part of maturation
-leaving home for the first time, completing school, or the birth of one’s first child
dissociative disorders
-disruption in the normally occurring linkages between subjective awareness, feelings, thoughts, behaviours, and memories
-Occur after significant adverse experiences or traumas
-Survivors try to avoid people or situations that might provoke memories of the trauma.
-Individuals respond to stress with severe interruption of consciousness
-Unconscious defense mechanism
-Protects individual against overwhelming anxiety through emotional separation
examples of dissociation
-derealization and depersonalization (the experience of self or the environment as strange or unreal)
-periods of disengagement from the immediate environment during stress, such as “spacing out”
-alterations in bodily perceptions
-emotional numbing
-out-of-body experiences
-amnesia for abuse-related memories
dissociative identity disorder
-(multiple personality disorder)
-Presence of two or more distinct personality states
-Each alternate personality (alter) has own pattern of
Perceiving
Relating to, and
Thinking about the self and environment
Psychotherapy first line
dissociative amnesia
-Inability to recall important personal information
-Often of traumatic or stressful nature
-Dissociative fugue - memory loss causes person to end up in an unexpected place, without any memory of how they got there
dissociative disorder treatment
Psychoeducation
Pharmacological interventions
Advanced-practice interventions
-Somatic therapy
Evaluation
children and adolescents
Children are more likely to be mentally healthy if they have normal physical and psychosocial development and a secure attachment at an early age.
The Mental Health Strategy for Canada: A Youth Perspective provided strategic directions for
Promotion
Prevention
Intervention and ongoing care
Research
Evaluation
Common Childhood Stressors
-Child → difficult temperament, birth difficulties, extreme sensitivity to sensory experiences, suspected abuse/neglect, loss of caregiver, xtreme activity level, aggressive behaviour, emotional dysregulation, substance use
Family → lacking parenting skills, unresolved trauma, developmental delay, financial and marital problems, chronic health issues, mental health issues, substance abuse, insensitivity, rejection, angry/harsh discipline, frightening behaviour
Residential community → Low SE neighborhood, overcrowding, poor housing, limited access to education, recreation, child care, medical care, etc.
mandatory reporting of abuse if
Child is 16 and under
1 type of abuse in children
neglect
grief
subjective experience that accompanies the perception of a loss. Children’s grief is shaped by developmental stages as well as experiences.
Children don’t understand permanence of death until age 7
personal fable
is an aspect of egocentric thinking in adolescence, characterized by the belief that one is unique and invulnerable to harm. This belief often leads to risk-taking behaviours such as unprotected sex, fast driving, and substance abuse
complicated grief
a form of bereavement-related distress that can include such symptoms as being preoccupied with thoughts of the deceased, including difficulty accepting the death, and numbness, bitterness, or a sense of futility
primary development task of adolescent
Test different roles and discover who they are
protective behaviours for adolescents
problem-solving skills
A supportive family environment,
Environmental supports
cohesive families, schools, and neighbourhoods.
Mental Health Assessment of Children and Adolescents
-more specific and fewer open-ended questions
-Simple phrasing
-Artistic and play media (e.g., puppets, family drawings) can be used to engage children
-It is critical to ensure what level of confidentiality can be provided to the youth in the context of an individual interview.
Bibliotherapy
use of books, stories, and other reading materials. It can be used to help children, adolescents, and families to gain information and understanding about life stressors, illness, and recovery
language disorders
Dyslexia (reading)
Dyscalculia (math)
Dysgraphia (written expression)
common features of personality disorders
-Impaired metacognition
-Maladaptive emotional response
-Impaired self identity and interpersonal functioning
-Impulsivity and destructive behaviour
-significant challenges in self-identity or self-direction,
-have problems with empathy or intimacy within their relationships.
-Treatment is difficult and complex, as people with these disorders may have difficulty recognizing or owning the fact that their difficulties are problems of their personality.
metacognition
the ability to consider and identify one’s own state of mind and that of others, reflect upon these mental states, and apply this knowledge to problem solving
personality disorders comorbidity
-Personality disorders frequently co-occur with disorders of mood and eating, anxiety, and substance misuse
-Personality disorders often amplify emotional dysregulation, a term that describes poorly modulated mood characterized by mood swings
-Life crises of any kind may be risk factors, for instance any grief, loss, or trauma
mentalization
The focus of MBT is assisting clients through a therapeutic process to learn about their mental states and then to explore how errors may lead to difficulties.
metacognitive interpersonal therapy
validating clients’ experiences and facilitating positive change
cluster A (social aversion)
Paranoid personality disorder (PPD)
Schizoid personality disorder (SZPD)
Schizotypal personality disorder (STPD)
-odd or eccentric behaviours(e.g., social isolation, detachment)
-perception distortions, unusual levels of suspiciousness, magical thinking and cognitive distortions
Cluster B (dysregulation in emotion and behaviour)
Antisocial personality disorder (ASPD)
Borderline personality disorder (BPD)
Histrionic personality disorder (HPD)
Narcissistic personality disorder (NPD)
-Respond to life’s demands with dramatic, erratic and at times chaotic traits
-Problems with impulse control, emotion processing and regulation, and interpersonal difficulties
